ICL 17.2: Post-Menopausal Bleeding Evaluation and Treatment Flashcards
68 year old present with vaginal spotting and has some complaints of pelvic prolapse, brought in by assistant living nurse
what next?
history and PE
abuse in living home?
medications, etc
47 year old present to your office after having an endometrial ablation 3 year sago. no bleeding past 3 years but has occasional night sweats. patient still gets some monthly mood changes and present to your office today with bleeding for 8 days
make sure tissue is normal before doing an ablation
menopause? so check for FSH levels if they’re elevated then she’s in menopause
57 year old diabetic present with bleeding for 3 days. she recently began to have intercourse again and didn’t know why her family doctor made her come in today for this visit
lining of vaginal dries up at menopause and can cause bleeding since it’s thin and during sex it can tear
cervical cancer can also be causing it but it’s probably atrophic vaginitis that’s the cause of her bleeding
50 year old patient present to your office for evaluation of bleeding. patient was recently diagnose with sebaceous adenoma and has a family history significant for colon and ovarian cancer.
what are you worried about?
Lynch syndrome!
stomach, pancreatic, uterine, kidney are also effects
risk factors for uterine cancer?
- endometriosis
- unopposed estrogen
- endometrial hyperplasia
- early menarche/latemenopause
- nullparity
- annovulation
- DM
- obesity
- granuloma cell tumor which secretes estrogen and inhibin B!
- family history**
how do OCPs effect risk of uterine cancer?
decrease uterine cancer
combined OCPs are progesterone dominant so they help limit estrogen that could cause uterine cancer
smoking also decreases uterine cancer risk!
why does obesity increase uterine cancer?
conversion of cholesterol to estrogen via aromatase
what are the usual causes of AUB at birth?
estrogen withdrawal
what are the usual causes of AUB less than 10 years old?
foreign body
infection
sarcoma botryoides
ovairian tumor
trauma
what are the usual causes of AUB less than 10 -menopause years old?
- anovulation
- function
- iatrogenic
- pregnancy: abortion, ectopic, placental polyp, retained products, trophoblastic diseases
- uterine infection, fibroids, hyperplasia, neoplasia
what are the usual causes of AUB after menopause
- atrophic vaginitis
- carcinoma
- estrogen replacement
which STD causes abnormal vaginal bleeding?
chlamydia
how long without a period till you technically have menopause?
1 year
what causes postmenopausal bleeding?
- exogenous estrogen
- atrophic endometritis/vaginitis
- endometrial cancer
- ——————— - endometrial or cervical polyps
what increases the risk of endometrial carcinoma?
- unopposed estrogen
- menopause after 52
- obesity
- nulliparity
- DM
- PCOS
- tamoxifen
- lynch syndrome
